Structural and Functional Involvement of Pituitary Gland in Wegener’s Granulomatosis

Barlas, Nauman Bashir; Hassan, Hamdy H.; Badr, Fahad B Al; Bilal, Aamir

doi:10.1007/s00062-010-0037-2

Cited by 16 publications

(7 citation statements)

References 5 publications

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“…Enlarged pituitary gland, enhancement of the periphery of the pituitary gland, sellar mass, and pituitary mass were the most common lesions in MRIs. [24][25][26] Patient three had a normal pituitary MRI image. However, PET-CT showed increased linear radioactivity uptake in the pituitary fossa.…”

Section: Discussionmentioning

confidence: 99%

Pituitary dysfunction in patients with ANCA associated vasculitis: prevalence, presentation, and outcomes

Zou

Lü

et al. 2020

Therapeutic Advances in Chronic Disease

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Background: The antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) are rare multisystem autoimmune diseases characterized by inflammatory cell infiltration causing necrosis of small blood vessels. Pituitary involvement in AAV is poorly described. This study aimed to describe the prevalence, clinical characteristics, and outcomes of pituitary involvement in patients with AAV. Methods: A total of 150 patients diagnosed with AAV and hospitalized in the China–Japan Friendship Hospital between 2009 and 2019 were enrolled in this retrospective study. Patients diagnosed with pituitary involvement in AAV were selected for inclusion. Results: Three patients (2%) were identified with pituitary involvement. Two patients had positive ANCA titers, one with proteinase 3 positive and one with myeloperoxidase positive antibodies. Pituitary dysfunction presented as an initial symptom in one patient and developed over the course of the diseases in the other two patients. All three patients had abnormal hormones. Among them, two patients had an enlarged pituitary, shown by magnetic resonance images (MRIs), and one patient had a normal sized pituitary, shown by MRI, but presented with increased linear radioactivity uptake in the pituitary fossa by positron emission tomography-computed tomography. All patients were treated with corticosteroid and immunosuppressive therapy. Both pituitary dysfunction and vasculitis were in remission. Conclusion: Pituitary involvement is uncommon in AAV and it can occur at any point during AAV. The main clinical manifestations are central diabetes insipidus and panhypopituitarism. Immunosuppressive therapy could significantly alleviate clinical symptoms as well as pituitary imaging.

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Section: Discussionmentioning

confidence: 99%

Pituitary dysfunction in patients with ANCA associated vasculitis: prevalence, presentation, and outcomes

Zou

Lü

et al. 2020

Therapeutic Advances in Chronic Disease

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“… DI Normal prolactin Normal TSH Constitutional, ENT cANCA+ve 26 35 M Diffusely enlarged pituitary and thickened stalk. DI ↓ TSH Constitutional, ENT, pulmonary cANCA +ve Xue 2009 [ 51 ] 19172275 1 63* 63 F Normal DI TSH normal LH & FSH normal Constitutional, pulmonary, peripheral neuropathy PR3 +ve Barlas 2011 [ 52 ] 21116602 1 35 37 F Anterior enlargement. Central area with low signal on T1 and high signal on T2.…”

Section: Discussionmentioning

confidence: 99%

Severe localised granulomatosis with polyangiitis (Wegener’s granulomatosis) manifesting with extensive cranial nerve palsies and cranial diabetes insipidus: a case report and literature review

et al. 2018

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BackgroundGranulomatosis with polyangiitis (GPA, formerly Wegener’s granulomatosis) is a multisystem vasculitis of small- to medium-sized blood vessels. Cranial involvement can result in cranial nerve palsies and, rarely, pituitary infiltration.Case presentationWe describe the case of a 32 year-old woman with limited but severe GPA manifesting as progressive cranial nerve palsies and pituitary dysfunction. Our patient initially presented with localised ENT involvement, but despite treatment with methotrexate, she deteriorated. Granulomatous inflammatory tissue around the skull base resulted in cavernous sinus syndrome, facial nerve palsy, palsies of cranial nerves IX-XII (Collet-Sicard syndrome), and the rare complication of cranial diabetes insipidus due to pituitary infiltration. The glossopharyngeal, vagus and accessory nerve palsies resulted in severe dysphagia and she required nasogastric tube feeding. Her neurological deficits substantially improved with treatment including high dose corticosteroid, cyclophosphamide and rituximab.ConclusionsThis case emphasises that serious morbidity can arise from localised cranial Wegener’s granulomatosis in the absence of systemic disease. In such cases intensive induction immunosuppression is required. Analysis of previously reported cases of pituitary involvement in GPA reveals that this rare complication predominantly affects female patients.

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“…Pituitary gland involvement is extremely rare complication of GPA. Only a few case reports have been published worldwide [3][4][5][6][7][8][9], and there has been no report in Korea so far. According to the prior study, less than 1% of patients with GPA have pituitary involvements [10].…”

Section: Discussionmentioning

confidence: 99%

“…Secondly, spreading of granulomas from adjacent anatomical areas such as sinus or orbit is another possibility. Lastly, in-situ new granuloma formation in pituitary gland tissue is also suggested [1,7,9]. The extent of pituitary involvement might be variable.…”

Section: Discussionmentioning

confidence: 99%

“…But rare cases with normal appearance of gland on imaging study were also reported [3,6,7]. Meanwhile, other granulomatous disease, for example, tuberculosis, sarcoidosis and histiocytosis may exhibit similar findings on MRI without clear differential criteria compared to GPA [7]. For the final diagnosis of GPA, a tissue confirmation is required considering the potential risk of subsequent treatment.…”

Section: Discussionmentioning

confidence: 99%

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Pituitary Granulomatosis with Polyangiitis Presenting with Central Diabetes Insipidus

et al. 2015

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We report on a case of limited form of granulomatosis with polyangiitis (GPA) with pituitary involvement which presented with central diabetes insipidus. This rare form of GPA has not been reported in Korea. The patient presented with fever, headache, productive cough, nasal symptoms, and polyuria. Laboratory data and imaging studies demonstrated inflammatory lesions in nasal sinus and lungs. Pituitary stalk thickening and enhancement were observed on brain magnetic resonance imaging. The histopathology of the lung lesions showed chronic active granulomatous inflammation. Polyuria, hyperosmolar hypernatremia, and decreased urine osmolality which responded to synthetic vasopressin analog were consistent with central diabetes insipidus.

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Structural and Functional Involvement of Pituitary Gland in Wegener’s Granulomatosis

Cited by 16 publications

References 5 publications

Pituitary dysfunction in patients with ANCA associated vasculitis: prevalence, presentation, and outcomes

Pituitary dysfunction in patients with ANCA associated vasculitis: prevalence, presentation, and outcomes

Severe localised granulomatosis with polyangiitis (Wegener’s granulomatosis) manifesting with extensive cranial nerve palsies and cranial diabetes insipidus: a case report and literature review

Pituitary Granulomatosis with Polyangiitis Presenting with Central Diabetes Insipidus

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